<html>    
	<head>
	<link href="templatemo_style3.css" rel="stylesheet" type="text/css" />
<link href="styles3.css"rel="stylesheet" media="screen" />
	</head>
	<body>
	<div id="templatemo_banner1">
    <div id="form_button">
    <form class="contact_form" action="./register.html" method="post" name="regform" onsubmit="return submitform();">
    <ul>
   		
			<li>
             <h2>Individual Client Registration </h2>
			 
              <span id="required"> * Denotes Required Field</span>
           </li>
		<li>
			<h4>Basic Information </h4>
            <label for="name">Name<font color="red" size="3">*</font></label>
            <input type="text" maxlength="20" name="txtfname" placeholder="First Name" required/>
			<input type="text" maxlength="20" name="txtmname" placeholder="Middle Name" required/>
			<input type="text" maxlength="20" name="txtlname" placeholder="Last Name" required/>
       	 </li>
		
        <li>
		<label for="type" >Gender:</label>
			<input id="r_button" type="radio" name="gender" value="Male" checked="checked"/>Male
			<input id="r_button" type="radio" name="gender" value="Female"/>Female
		</li>
		
		<li>
		     <label for="email">Email<font color="red" size="3">*</font></label>
            <input type="email" name="txtemail" placeholder="john_doe@example.com" required/>
        	
        </li>
		
        <li>
           <label for="number">Mobile Number<font color="red" size="3">*</font></label>
            <input type="text" maxlength="10" name="txtmobno" placeholder="Mobile Number" required />
        </li>
		
		
		
		<li>
           <label for="date">Date Of Birth<font color="red" size="3">*</font></label>
            <input type="text" maxlength="10" name="txtdateb" placeholder="Date of Birth" required />
        </li>
		<li>
           <label for="nat">Nationality<font color="red" size="3">*</font></label>
            <input type="checkbox" name="Nationality" value="Indian">Indian <input type="checkbox" name="Nationality" value="NRI">NRI<br/>
        </li>
		<br/>
		<h4>Bank Detail </h4>
	
		 <li>
           <label for="pan">Pan Number<font color="red" size="3">*</font></label>
            <input type="text" maxlength="10" name="txtpanno" placeholder="Pan Number" required />
        </li>
		
		 <li>
           <label for="demat">Demat Account Number<font color="red" size="3">*</font></label>
            <input type="text" maxlength="10" name="txtdematno" placeholder="Demat Account Number" required />
			
		</li>
		<br/>
		
	<h4>Location Detail </h4>
		
		 <li>
           <label for="address">Address<font color="red" size="3">*</font></label>
		   
		   <textarea rows="2" cols="25"  name="txtaddress" placeholder="Address" required>
           
			</textarea>
			<select name="State">
			<option value="" selected="selected" >---State---</option>
			<option value="state">Maharashtra</option>
			<option value="state">Gujrat</option>
			<option value="state">Delhi</option>
			</select>
			
			<select name="City">
			<option value="city" selected >---City---</option>
			<option value="mumbai">Mumbai</option>
			<option value="pune">Pune</option>
			</select>
       
        </li>
        	<br/>
		
		<h4>Account Detail</h4>
		<li>
            <label for="Password">Password<font color="red" size="3">*</font></label>
            <input type="password" name="txtpassword" placeholder="password"  required />
      
        </li> 
		
        <li>
            <label for="Password">Confirm Password<font color="red" size="3">*</font></label>
            <input type="password" name="txtcpassword" placeholder="confirm password" required />
      
        </li> 
		
        <li>
        	<button class="submit" type="submit">Register</button>
			<button class="reset" type="reset" onclick="reset_msg()">Reset</button>
        </li>
    </ul>
</form>
    </div>
    </div>
	</body>
	</html>